chapter 57 Flashcards
The figure shows an unenhanced CT of a patient with left-sided weakness. What is the affected vessel? A. Anterior cerebral artery B. Middle cerebral arterv C. Posterior cerebral artery D. Basilar artery
a
Which of the following are recognized lacunar syndromes?
1. Pure motor stroke
2. Pure sensory stroke
3 Dysarthria-clumsy hand syndrome
4. Hemianopia Select:
A = 1,2 3.8= I, 3. C = 2, 4. D = 4 oaly. E = All
a
A man presents with left Homer’s syndrome, loss of pain and temperature sensation of the face
on the left, and loss of pain and temperature sensation of the right side of the body. In addition,
he has left-sided appendicu!?r ataxia which appears to be cerebellar.
Which blood vessel occlusions can produce this finding?
1. Basilar artery
2. Posterior inferior cerebellar artery
3. Posterior cerebral artery
4. Vertebral artery
Select: A = 1, 2, 3. B = 1, 3. C - 2. 4. D = 4 only. E = All
c
The image is from a CT of a patient who presents for evaluation of memory loss.
Which of the following findings would be expected from the location of the lesion?
1. Right hemianopia
2. Alexia
3. Anterograde amnesia
4. Agraphia
Select: A = 1. 2, 3. B = 1. 3. C = 2. 4. D - 4 only. E = All
a
Which of the following predispose to watershed infarction?
1. Cardiac arrest
2. Prolonged hypoxia
3. Cardiac surgery
4. Cardiac valvular disease
Select: A= 1,2, 3. B= 1, 3. C - 2, 4. D = 4 only. E = All
a
The figure shows a left carotid angiogram of a patient with TIA affecting the right arm and leg. A. Left ICA dissection B. Left ICA intraluminal thrombus C. Left ECA stenosis D. Left-ECA dissection
b
The image is the AP view of a left carotid angiogram of a patient with small stroke with right hemiparesis. What is shown in the angiogram? A. Dissection B. Intracranial carotid stenosis C. Moya-inoya disease D. Vasculitis
c
Which of the following are autosomal dominant causes of thromboembolic disease?
1. Activated protein C resistance
2. Protein S deficiency
3. Protein C deficiency
4. Antithrombin-III deficiency
Select: A = 1,2, 3. B = I, 3. C = 2, 4. D = 4 only. E = All
e
What is the risk of stroke in patients with primary antiphospholipid antibody syndrome without
other underlying disease?
A. Little or no increased risk of stroke
B. Moderate increase in stroke risk, although not as much as with associated autoimmune disorder
C. Marked increase in stroke risk
a
A patient presents to the ED with right hemiparesis and aphasia. The symptoms were present
upon awakening, less than an hour ago. Routine laboratory studies including coagulation studies
are normal. CT is normal Which is the best approach to treatment?
A. Intravenous t-PA
B. Intra-arterial t-PA
C. Neither
c
A 38-year-old female is admitted because of headache, vomiting, transient visual obscurations,
and she then develops seizures. MRI shows multifocal venous infaictions and MRV shows
venous thrombosis. There is a small amount of petechial biood in some of the areas of infarction.
Which is the best management option9
A. Heparin intravenously
B. Low molecular weight heparinoid
C. Warfarin
D. No anticoagulation
a
Which is the greatest risk factor for intracerebral hemorrhage? A. Aneurysm B. Anticoagulation C. Atherosclerotic disease D. Hypertension
d
What is the implication of ICH as a complication of intra-arterial thrombolytic therapy?
A. A rare complication with a good prognosis
B. A rare complication with a poor prognosis
C. A common complication with a good prognosis
D. A common complication with a poor prognosis
d
A 25-year-old man is brought to the ED having collapsed at home. lie has a right hemiparesis
with marked encephalopathy. His is known to use cocaine regularly and drug screen is positive.
Which is the diagnosis?
A, Intraparenchymal hemorrhage
B. Subarachnoid hemorrhage
C Cerebral infarction
D. Any of these
d
A man is admitted because of left hemiparesis and is found to have a right intraparenchymal
hemorrhage on CT. » he blood is mottled with minimal mass effect. There is no extension of the
blood into the ventricular or subarachnoid space. What is the most likely cause of the
hemorrhage?
A. Aneurysmal hemorrhage
B. Hypertensive hemorrhage
C. Hemorrhagic infarction
D. Venous infarction with hemorrhage
c
The image shows CT of a young man with stroke following cocaine use.
Which would be appropriate therapy for this patient?
A. Medical management
B. Open surgical drainage
C. Opening of the skull 10 allow for increased ICP
D. Ventricular drainage
a
Which imaging study is most sensitive for identification of subarachnoid blood? A. CT B. CT angiography C. MRI D MR angiography
a
A patient is found on MRI performed for hemispheric stroke to have a fusiform aneurysm of the
basilar artery. This is not in the vascular distribution to produce the presenting symptoms. Which
of the following is the main risk of this finding?
A. Subarachnoid hemorrhage
B. Intracerebral hemorrhage
C Infarction
D. Any of these
c
Which of the following is the most common complication of SAH? A. Cerebral infarction B. Hydrocephalus C. Recurrent hemorrhage D. Seizures
a
Which of the following are reasonable approaches for prevention and management of vasospasm
in patients with SAH?
1. Nimodipinc
2. Endovascular balloon dilatation
3. Maintenance of good cardiac output
4. Dehydration to minimize edema
Select: A = 1,2,3.B = 1, 3. C = 2, 4. D = 4 only. E = All
a
A patient presents with subarachnoid hemorrhage and has angiography on the second hospital
day that shows no visible aneurysm. How would you advise the patient regarding restudy?
A. Restudy is not warranted because of the negative cerebral angiogram
B. Restudy with cerebral angiography is needed 7-10 days later because of the possibility of
missing an aneurysm on early angiography
C. Restudy with MRA is needed 1 -2 weeks following the hemorrhage because of the risk of
missing an aneurysm on early angiography
b
Which of the following imaging modalities is best able to identify and characterize a cavernous malformation? A. Angiography B. CT C. MRI D. PET
c
Which of the following are potential presentations of arteriovenous malformations?
1. Seizures
2. Headaches
3. Hemorrhage
4. Infarction
Select: A = 1,2, 3. B = 1, 3. C = 2,4. D = 4 only. E - All
e
A patient with partial seizures with secondary generalization is found to have a cavernous
malformation. There is no sign of past or recent bleeding. Which is the best approach to therapy?
A. Surgical excision
B. Stereotactic radiosurgery
C. Medical therapy of the seizures
c
Decisions as to whether to operate on an AVM are often complex. Which of the following
features would tend to argue in favor of surgery?
1. Small lesion
2. Accessible location
3. Sign of previous hemorrhage
4. Deep venous drainage
Select: A= 1.2.3. B- l,3.C = 2,4. D =4 only. E = A i I
a
The image shown is a Ti-weighted sagittal MRI. What is the most likely diagnosis? A. AVM B. Cavernous angioma C. Capillary telangiectasia D. Venous angioma
b
What is the most common presentation of stroke in neonates? A. Apnea B. Hemiparesis C. Seizures D. Spastic diplegia
c
Which of the following imaging modalities is best able to identify and characterize a cavernous malformation? A. Angiography B. CT C. MRI D. PET
d
Which of the following are potential presentations of arteriovenous malformations?
1. Seizures
2. Headaches
3. Hemorrhage
4. Infarction
Select: A = 1,2, 3. B = 1, 3. C = 2,4. D = 4 only. E - All
c
A patient with partial seizures with secondary generalization is found to have a cavernous
malformation. There is no sign of past or recent bleeding. Which is the best approach to therapy?
A. Surgical excision
B. Stereotactic radiosurgery
C. Medical therapy of the seizures
no highlights
Decisions as to whether to operate on an AVM are often complex. Which of the following
features would tend to argue in favor of surgery?
1. Small lesion
2. Accessible location
3. Sign of previous hemorrhage
4. Deep venous drainage
Select: A= 1.2.3. B- l,3.C = 2,4. D =4 only. E = A i I
d
The image shown is a Ti-weighted sagittal MRI. What is the most likely diagnosis? A. AVM B. Cavernous angioma C. Capillary telangiectasia D. Venous angioma
b
What is the most common presentation of stroke in neonates? A. Apnea B. Hemiparesis C. Seizures D. Spastic diplegia
c
The image is a fast spin echo MRI of a young child with leukemia who presented with headache
and left hand numbness. Which is the most likely diagnosis ?
A. Multuple arterial emboli
B. Vasculitis
C. Spontaneous cortical hemorrhages
D. Venous thrombosis
d
A child with wtroke has totally negative studies including MRI, MRA, transthoracic
echocardiogram and basic laboratory studies for coagulopathy. The patient has a large vessel
stroke which suggested proximal embolus. Which is the next step in eveluatiuon and
management?
A. Antiplatelet treatment without further studies
B. Cerebral angiogram
C. Transesophageal echo
D. Warfarin therapy without further studies
c
Patients with down synbdrome are of increased risk of which of the following?
- Cerebral hemmorage
- Cerebral infarction
- Vertebral dissection
- Moya – moya E
e
The image shows use of vertebrobasilar MRA of a 4 yr old male who presents with vertigo,
vomittting and ataxia. This developed after he has been wrestling with his sister. Which is the
most likely cause of his symptoms ?
A. Cardioembolic stroke
B. Lacunar infarction
C. Vascular malformation
D. Vertebral dissection
d
A 70 year old man presents with two episodes of leg weakness associated with activityt. The
episodes improve within 15 minutes. Spinal caludication is considered, but there is no
significant cord compression on MRI. Which is the likely cause?
A. Cord compression which was missed on MRI
B. Femoral arterial insufficiency
C. Intermittent cord ischemia from aortic atherosclerosis
D. Transverse myelitis
c
How does the clinical presentation of spinal venous infarction differ from arterial infarction?
A. Arterial infarctions produce more one sided deficits whereas venoms infarctions produce
bilateral deficits
B. Arterial infarctions produce
secondary hemorrhagic changes in the cord, whereas venous infarctions only rarely do
C. There is no substantia] difference in presentation
c
Which is the best method for imaging spinal cord ischemia? A. CT B. MRI C PET D. Myelography
b
A 57-year-old man presents with quadriparesis with the legs being more affected than the arms.
He carries the diagnosis of MS, and has been wheelchair bound for 5 years. He has had stepwise
worsening of myelopathy. MRI of the brain shows some punctate areas of increased signal
intensity on T2-weighted imaging. MRI of the cervical spine is shown in the image.
What is the most likely diagnosis?
A. Multiple sclerosis
B. Spinal aneurysm
C. Spinal AVM
D. Transverse myelitis
c
A patient with known isolated CNS vasculitis presents to the ED with confusion and headache
and mi Id left hemiparesis. Which is the most likely?
A. Arterial infarction D. Venous infarction C. Hemorrhage
c
A patient presents with one of multiple episodes of cerebral ischemia and the MRI shows
multifocal ischemic change suggesting vasculitis. Angiography does not show vasculitis
changes. What other studies are indicated?
A. Brain biopsy alone
B. CSF analysis alone
C. CSF analysis and brain biopsy
D. None of these
c
A 60-ycar-old man presents with right hemiparesis and aphasia 3 weeks following herpes zoster
in the left VI distribution. What is the relationship between the zoster and the infarction?
A. The stroke is unrelated
B. The stroke can be a direct late consequence of the zoster
C. The stroke indicates recurrence of the zoster is imminent
b
A patient with a history of drug abuse presents with left hemiparesis. Examination is consistent
with right MCA infarction. There are needle tracks on the neck. Which is the most likely
diagnosis?
A. Endocarditis
B. Polyarteritis nodosa
C. Talc emboli from injection
D. Vasculitis due to drug abuse
c
